Well and easily explained hypospadiasis

1. HYPOSPADIAS
PREPARED BY
SHEENA BHATIA
 ASSISTANT PROFESSOR

2. HYPOSPADIAS

3. DEFINITION
Hypospadias is the most common
congenital anomaly of the penis.
In this anomaly the urethral opening is
situated on the ventral side of the shaft of
penis in one or several positions, just behind
the glans.

4. CLASSIFICATION BASED ON MEATAL OPENING

6. ETIOLOGY
 Unknown
 Arrested development in fetal life.
 Familial factor
 Gene mutation
 Lack of hormone production during
fetal life due to endocrinopathies

7. PATHOPHYSIOLOGY
Due to incomplete fusion of urethral folds along the midline
Severity of condition depends on the location of opening
 The presence of opening near glans is known as Glandular
Hypospadias
 Presence of opening at corona is known as Coronal Hypospadias.

8. CONT……………….
 Presence of opening at shaft is known as Penile
Hypospadias.
 Opening at junction of penis and scrotum is known as
Penoscrotal Hypospadias
 Presence of opening at perineum is known as Perineal
Hypospadias

9. SYMPTOMS
Abnormal urine stream
Sexual Dysfunction
later in life.
Fertility Problems
Psychological problems
may arise.

10. ASSESSMENT
 Abnormal pattern of voiding.
 Stream of urine may be deflected downward.
 Child voids in sitting position in penoscrotal and perineal
Hypospadias.
 In Glandular or coronal hypospadias child able to voids in
standing position, by tilting the penis slightly upward

11. MANAGEMENT
 There is no medical management for this defect.
 Surgery may be recommended for its correction and the
goals of surgery are:-
 To bring the urethral opening to the tip of the penis via a
procedure known as Urethroplasty.
 To straighten the penis.
 Circumssion of the foreskin should be avoided as this
foreskin should be used for surgical repair.
 Surgery should be done preferably at the age of 6 -24
months of age.

12. NURSING MANAGEMENT
PREOPERATIVE CARE
Preparing parent’s for child surgery.
Psychological support should be given to the
parents

13. POST OPERATIVE CARE
 Monitor vital signs
 Catheter care should be given
 Put restraints so that child should not take out catheter or other
tubings.
 Urine examination should be done to rule out any infection.
 Support and guidance of parents is very important.

14. NURSING RESEARCH
 Background: Hypospadias is the most common birth
defect among children affecting the penis
characterized by ventral position of urethral meatus
in which caused by arrest of normal development of
the urethra.
 Aim of the Study: To evaluate the effect of pre-
operative instructions for mothers on selected post-
operative outcomes among their children with
hypospadias.

15.  Subjects and Methods: A quasi-experimental research design
(pre-post test) was used to achieve the aim of the current
study. A convenient sample of 60 mothers having male
children undergoing surgical repair of hypospadias
participated in the current study, divided into two equal
groups: 30 as a control group and 30 as a study group who
were subject to the preoperative instructions. The setting
was in-patient Pediatric Surgical Department at Cairo
University Specialized Pediatric Hospital (CUSPH). The
required data was collected through: 1- Structured interview
(questionnaire); 2- Mothers' knowledge and reported practice
assessment sheet (pre-post test) and 3- Post-operative
outcomes assessment record.

16. CONT……………
Results: The study's results revealed that, children in the study group
exposed to less early post-operative complications such as (bleeding,
wound dehiscence, urinary obstruction and urinary catheter fall) than
children in the control group. Late post-operative complications (fistula,
meatal stenosis, urethral obstruction and infection) occurred in children
in the study group less than those in the control group. Children in the
study group had appropriate cosmetic appearance of the penis and
functional outcome than children in the control group.
Conclusion: The current study concluded that children whom mothers
received the pre-operative instructions about hypospadias had improved
outcomes in relation to less complications, higher cosmetic and
functional outcomes than children in the control group.

17.  Recommendation: It was recommended that
provision of pre and post-operative care of
children undergoing hypospadias repair is
mandatory to achieve satisfactory post-operative
outcomes.

18.  THANK YOU